Provider Demographics
NPI:1831510379
Name:LUETKEMEYER, REBEKAH ANN (SLP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ANN
Last Name:LUETKEMEYER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROCHEPORT
Mailing Address - State:MO
Mailing Address - Zip Code:65279-9835
Mailing Address - Country:US
Mailing Address - Phone:573-864-6622
Mailing Address - Fax:
Practice Address - Street 1:1024 ADAMS ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3408
Practice Address - Country:US
Practice Address - Phone:573-635-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist